The main limiting factor in patient retention was adverse drug reactions. Patients taking lamotrigine (LTG) or gabapentin (GBP) did better than those taking carbamazepine. Seizure control was similar among groups. LTG and GBP should be considered as initial therapy for older patients with newly diagnosed seizures.

Epilepsy in elderly patients, compared with the younger adult population, differs in etiology, clinical presentation, and prognosis. Challenges in the pharmacologic treatment of epilepsy in the elderly include the following: the physiologic changes associated with aging; adverse events to which the elderly are especially vulnerable; the increased risk for these patients, who are often taking multiple medications; and toxicity from drug-drug interactions. This article presents data on efficacy and safety from clinical trials of newer antiepileptic drugs (AEDs) in elderly patients compared with older AEDs. We discuss the implications of the findings using newer-generation AEDs in the Veterans Affairs Cooperative Study (VACS) #428 in order to educate physicians involved in choosing appropriate AEDs for older patients. In the elderly patient population, an optimal treatment outcome of seizure control with minimal or no adverse events is dependent on the well-informed choice of an AED by a physician.

Perioperative nurses are situated uniquely to promote good traffic control practices in the OR. This study was conducted to explore the effect of traffic patterns, specifically the number of people in the OR, on the incidence of surgical site infections (SSIs). Researchers analyzed 2,864 clean surgical procedures performed in 1995 in an academic medical center. Duration of surgery and American Society of Anesthesiologists' physical assessment score were statistically significant risk factors for SSIs. A rising trend in SSIs was observed as the number of people in the OR increased; however, it was not statistically significant. Risk factors for SSIs must be better understood to develop more effective prevention programs.

SUMMARYPurpose: Pharmacokinetics of antiepileptic drugs (AEDs) can be altered by age-related changes in physiology, thereby altering clinical effects, especially tolerability, in older adults. We compared two dosages of topiramate (TPM) in a pilot study of patients ≥60 years of age with partial-onset seizures. Methods: In this 24-week, double-blind, randomized, parallel-group study, patients with one or more seizures in previous 6 months were randomized to treatment with 50 or 200 mg/day TPM. TPM was initiated as monotherapy or added to one AED and titrated by 25 mg/day per week to target or maximum tolerated dose as the concomitant AED, if any, was withdrawn. Results: Thirty-eight patients were randomized to the 50 mg/day TPM (mean age, 68 years) and 39-200 mg/day TPM (69 years). Seizure control was similar with the two dosages when TPM could be used as monotherapy, whereas 200 mg TPM was more effective than 50 mg in patients requiring adjunctive therapy. The overall incidence of adverse events was similar for the two dosages-66% with 50 mg and 62% with 200 mg TPM. Most common adverse events were somnolence (TPM 50, 13%; TPM 200, 8%), dizziness (13% vs. 8%), and headache (13% vs. 5%). Of 10 (13%) patients reporting a cognitive-related adverse event, six patients were assigned to the 50-mg group. A total of 14 patients (18%; seven in each group) discontinued TPM due to adverse events. Conclusions: This pilot study supports the practice of using low-to-moderate dosages of AEDs in older adults.

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